ArticlePDF Available

Differences in Preseason Aerobic Fitness Screening in Professional and Pre-Professional Modern Dancers

Authors:
  • ADAM Center
  • Weill Cornell Medical College

Abstract and Figures

The aerobic demands of today's dance repertoire warrant understanding of the current cardiorespiratory fitness of dancers. The purpose of this study was to compare aerobic fitness levels of professional and pre-professional modern dancers and determine change over time. A retrospective analysis of four groups, two professional, and two pre-professional, was conducted in preseason annual screens, occurring before the professional dancers' rehearsal period and the students' academic training. Resting (HRrest), peak (HRpeak), and recovery (HRrecov) heart rate, and blood pressure (BP) were compared in 577 dancers, using an accelerated 3-minute step test. Smoking, asthma, and aerobic and cross training rates between groups were also compared. A 4 (group) X 2 (gender) MANOVA design determined differences between groups and genders in all dependent variables (p < 0.05). Using a repeated measures ANOVA design, we compared a subgroup over 3 years and one pre-professional group over 4 years. There were differences between groups in systolic BP and all HR variables (p < 0.001). Professional dancers reflected better cardiorespiratory fitness than pre-professional dancers. There were differences between groups in aerobic and cross training activities but no differences in smoking incidence or asthma rates. Pre-professional dancers demonstrated improvement in aerobic fitness over time (p = 0.006) while professionals did not change. Professional dancers display better aerobic fitness, which may reflect their performance demands. Wellness programs appear to enhance fitness in pre-professional dance students over time. Additional aerobic training is recommended for pre-professional modern dance students to prepare them for the performance demands of a professional career.
Content may be subject to copyright.
11
Shaw Bronner, P.T., Ph.D., O.C.S., Director, ADAM Center and Associate
Professor, Dept. of Physical erapy, Movement and Rehabilitation Sciences,
Northeastern University, Boston, Massachusetts; and Director, Physical erapy
Services, Alvin Ailey American Dance eater, New York, New York. Emma
Codman, ADAM Center, Department of Physical erapy, Movement and
Rehabilitation Sciences, Northeastern University, Boston, Massachusetts. Dana
Hash-Campbell, M.F.A., Chair, Dept. of Performing Arts, Long Island University,
Brooklyn, New York. Sheyi Ojofeitimi, D.P.T., C.F.M.T., O.C.S., Senior Research
Associate, ADAM Center; Senior Physical erapist, Alvin Ailey American Dance
eater, New York, New York; Synthesis Physical erapy, Brooklyn, New York.
Correspondence: Shaw Bronner, P.T., Ph.D., O.C.S., ADAM Center, 308B
Robinson Hall, Northeastern University, 360 Huntington Avenue, Boston,
Massachusetts 021150; shaw.bronner@gmail.com.
Copyright © 2016 J. Michael Ryan Publishing, Inc.
hp://dx.doi.org/10.12678/1089-313X.20.1.11
Abstract
The aerobic demands of today’s dance
repertoire warrant understanding of the
current cardiorespiratory tness of dancers.
e purpose of this study was to compare
aerobic tness levels of professional and
pre-professional modern dancers and de-
termine change over time. A retrospective
analysis of four groups, two professional,
and two pre-professional, was conducted in
preseason annual screens, occurring before
the professional dancers’ rehearsal period
and the students’ academic training. Rest-
ing (HRrest), peak (HRpeak), and recovery
(HRrecov) heart rate, and blood pressure
(BP) were compared in 577 dancers, using
an accelerated 3-minute step test. Smoking,
asthma, and aerobic and cross training rates
between groups were also compared. A 4
(group) X 2 (gender) MANOVA design
determined dierences between groups
and genders in all dependent variables
(p < 0.05). Using a repeated measures
ANOVA design, we compared a subgroup
over 3 years and one pre-professional
group over 4 years. ere were dierences
between groups in systolic BP and all HR
variables (p < 0.001). Professional dancers
reected better cardiorespiratory tness
than pre-professional dancers. ere were
dierences between groups in aerobic and
cross training activities but no dierences
in smoking incidence or asthma rates.
Pre-professional dancers demonstrated
improvement in aerobic tness over time
(p = 0.006) while professionals did not
change. Professional dancers display bet-
ter aerobic tness, which may reect their
performance demands. Wellness programs
appear to enhance tness in pre-profession-
al dance students over time. Additional
aerobic training is recommended for pre-
professional modern dance students to
prepare them for the performance demands
of a professional career.
Many professional dance
companies in the USA
have adopted the common
post-hire preseason screening program
developed by the Medical Taskforce
of Dance/USA.1 e main purpose
of the dance screen is to identify
potential health problems and areas
of concern, with the goal of address-
ing those issues prior to beginning a
season of technique classes, rehearsals,
and performances.
Preparticipation physical examina-
tions are mandatory for all collegiate
student-athletes in the USA.2 Increas-
ingly, pre-professional dance training
programs are adopting preseason
screens to assess incoming students’
health status.3-6 Results from dancer
screenings are often incorporated into
wellness programs within the dance
curriculum7-9 or as part of company
healthcare.10 Increased awareness of
tness, participation in injury preven-
tion and cross training programs, and
aerobic and technical11 demands of to-
day’s repertoire on all dancers empha-
size the importance of understanding
the current cardiorespiratory tness
of these individuals. e relationship
between fatigue and dance injury12-14
suggests that aerobic tness training
to reduce fatigue is warranted. Al-
though recent research in the UK has
focused on tness in the contempo-
rary dancer,15-20 it is currently unclear
whether contemporary dance and
modern dance are interchangeable
or have diering training and perfor-
mance requirements. Currently, data
on the cardiorespiratory tness levels
of professional and pre-professional
modern dancers are limited.
Two modern dance based pre-
professional university programs and
two modern dance companies have
Dierences in Preseason Aerobic Fitness
Screening in Professional and Pre-Professional
Modern Dancers
Shaw Bronner, P.T., Ph.D., O.C.S., Emma Codman, Dana Hash-Campbell, M.F.A., and
Sheyi Ojofeitimi, D.P.T., C.F.M.T., O.C.S.
Proofs to: shaw.bronner@gmail.com
12
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
used a common demographic intake
and preseason screen for over 10 years.
e two companies and one of the
university programs are housed within
one organization. All four groups
undergo common technique training
that includes Horton, Graham, ballet,
African, and other dance forms. When
comparing dancers of dierent training
levels, the investigators asked whether
pre-professional dancers are undergo-
ing adequate aerobic training to meet
the demands of a professional career.
e purposes of this study were to:
1. investigate dierences in aerobic
tness parameters, such as peak and
recovery heart rate (HR), between
groups and genders using an acceler-
ated 3-min step test; and 2. investigate
the effects of training variables on
dancers’ aerobic tness over time in
repeated annual screenings. Aerobic t-
ness was dened using several variables,
including resting HR (HRrest), peak
heart rate (HRpeak), heart rate recovery
(HRrecov), and tness rating as dened
by the accelerated 3-min step test.21,22
Methods
Data for this study were compiled
from preseason annual screens oc-
curring each year at the beginning
of the professional dancers’ rehearsal
period or students’ academic training.
The screens were conducted from
1998 to 2012, either as 1. part of the
larger 30-min post-hire Dance/USA
screen for professional dancers,21 or
2. part of the incoming 60-min dance
screening for pre-professional students
enrolled in one of two Bachelor of
Fine Arts (BFA) university programs.
A priori calculations for four groups,
with a power of 95% and α = 0.05,
determined a total sample size of 372
dancers. e majority of participants
were only screened one time. A subset
of that group was re-screened in sub-
sequent years, aording a snapshot of
change over time.
e screen consisted of a demo-
graphic and medical history question-
naire, followed by physical assessment.
e screens were conducted at the
rehearsal studios of the companies
and schools and were administered
by healthcare professionals, mostly
physical therapists involved in the
creation of the standardized screen
and its guidelines. ese same trained
individuals administered the assess-
ments from year to year.
Participants were either employed
by their dance company (Prof-Sr and
Prof-Jr) or enrolled in their respective
BFA program (BFA-1 and BFA-2) and
participated voluntarily in the study.
Screening of the Prof-Sr company,
comprised of 30 dancers, was initi-
ated in 2006 with the development of
the Dance/USA Task Force screening
project. All dancers were screened that
rst year. A subset of those dancers
was re-screened in consecutive years
(N = 15). Generally, due to time
constraints and touring schedule, only
newly hired dancers were screened in
the Prof-Sr company. erefore, in
any given year, out of 30 company
dancers, one to ve new dancers were
screened. In the Prof-Jr company, all
12 dancers were screened each year. As
this is a training company, there is a
turnover of approximately 50% each
year. In exceptional circumstances, a
dancer stayed a third year and was re-
screened that year as well. e number
of incoming freshmen in the BFA
programs uctuated from year to year,
ranging from 19 to 34 in BFA-1 and
8 to15 in BFA-2. Dancers in BFA-1
were generally not re-screened annu-
ally unless they specically requested
it. e BFA-1 dancers that were re-
screened were included in the repeated
measures analysis of screening at three
time points (N = 13). Dancers at the
BFA-2 school, because it is a small
program, were re-screened annually
throughout their 4 years (N = 38). For
professional dancers, all screens were
completed in a single session during
the rehearsal period at the start of the
company’s contract year. For incom-
ing students, all screens were com-
pleted in a single session at the onset
of the fall semester. Each participant
gave written informed consent and the
Institutional Review Board for Hu-
man Ethics granted ethical approval
for this study.
Experimental Protocol
Aerobic tness was tested using an
accelerated 3-min step test.21,22 e ac-
celerated step test was previously vali-
dated against an incremental treadmill
test comparing HRpeak, HRrecov, max-
imal VO2, (VO2 max), and recovery
VO2 (VO2 recov).22 HR was measured
using Polar USA (Warminster, PA)
HR monitors secured to each dancer’s
chest, with a receiver-watch worn
on the wrist. Dancers wore running
shoes and sat quietly for 5-min before
HRrest and blood pressure (BP) were
recorded. Participants were tested us-
ing a 0.305 m (12”) step for 3-min at
a rate of 112 steps·min-1, maintained
by a metronome. The metronome
was started prior to the test to allow
the dancers to familiarize themselves
with the tempo. ey were instructed
to step “up, up, down, down” to the
beat of the metronome. HRpeak was
recorded at 3-min. Dancers were
seated immediately after completing
the test, and HRrecov was recorded
at 1-min following completion of
the step test. After removing their
footwear, each dancers height (m)
was measured using a wall-mounted
rigid tape measure, and mass (kg) was
measured with a digital scale (Omron
Scale HBF-300, Omron Healthcare
Inc., Lake Forest, IL).
BMI was calculated from each
dancer’s height and mass. Each dancer
was assigned a tness rating based on
gender, age, and HRrecov step test
results, according to YMCA step test
guidelines.23,24 Previous validation of
the accelerated step test in dancers
found correlation of tness rating to
HRrecov was very high (r = 0.98).22
Because male and female HRrecov can
dier by age and gender, the tness
ratings dierentiate these variables
by gender. Fitness ratings, as dened
by the YMCA and ACSM,23,24 were
applied to the accelerated step-test
results as currently used in the Dance/
USA Post-hire Health Screen for Pro-
fessional Dancers25 and by a number
of collegiate pre-professional dance
programs throughout the USA. e
seven-category rating is 0 = Excellent,
1 = Good, 2 = Above Average, 3 =
Average, 4 = Below Average, 5 = Poor,
6 = Very Poor.
Data Analysis
Demographic information regarding
age, height, mass, years of dance train-
13
Journal of Dance Medicine & Science • Volume 20, Number 1, 2016
ing, years as a professional dancer, and
whether the individual had a history
of asthma, smoking, or participated in
supplemental cross training or aerobic
training was entered into a database in
Excel. Cross training was dened as all
non-dance and non-aerobic activities
such as strength training, stretching,
Pilates, Gyrotonics, yoga, etc. Aerobic
training was dened as activities such
as biking, swimming, running, ellipti-
cal walker, speed walking, stair master,
etc. e number of positive answers to
smoking, asthma, cross training, and
aerobic training was calculated as a
percentage of total answers. For aerobic
and cross training, participants were
asked to give examples in each category
to determine whether they understood
the question, as well as number of
hours and frequency of training each
week, to validate that they met our
criteria for a positive answer.
Comparisons were made between
the two professional and two pre-pro-
fessional groups, with respect to age,
height, and mass, using a 4 (group)
X 2 (gender) MANOVA for the three
dependent variables in SPSS (21.0,
IBM Corp, Armonk, NY). A second
4 X 2 MANOVA examined years of
dance training and BP (systolic and
diastolic). A third 4 X 2 MANOVA
evaluated the outcome variables,
HRrest, HRpeak, HRrecov, and tness
rating. Each dependent variable was
checked for outliers using Mahala-
nobis distance values. ose outliers
exceeding the cut o determined by
Χ2 table were eliminated (N = 3).
Multivariate variables were checked
for linearity, multi-collinearity, and
homogeneity of variance and covari-
ance (Box’s M test), and for individual
variables, Levene’s test was applied. As
several assumptions were violated, Pil-
lai’s trace was used for unequal sample
size. With a selected signicance of
p < 0.05, an adjusted significance
value and condence intervals were
calculated using Bonferroni correc-
tions (p < 0.0167 and 0.0125 for
three and four dependent variables,
respectively). Post hoc analyses were
conducted using Schee’s tests for
unequal sample size.
Asthmatic and smoking status and
aerobic and cross training were coded
for presence or absence. Again, they
were tested for assumptions of nor-
mality. As several assumptions were
violated, adjustments were made as
listed above, with a corrected signi-
cance value of p < 0.025.
Pearson product moment and
Spearmans rho correlations were used
to determine whether there was a
relationship between dancers’ HRrest,
HRpeak, tness rating, BMI, age, BP,
and HRrecov.
For those dancers who were re-
screened over several years, a repeated
measures ANOVA for Group X Time
was conducted to ascertain any chang-
es in cardiorespiratory parameters, p
< 0.05. Mauchly’s test was examined
for violations of sphericity. In the case
of signicance, the Huynh-Feldt cor-
rection was applied to the degrees of
freedom (DOF) and F-value. ere
were no cases of sphericity. e analy-
sis of 3 years included all four groups,
and the analysis of 4 years examined
BFA-2 only. Pairwise comparisons
were conducted where there was a
signicant main eect.
Results
Demographic Characteristics
Data were collected from 577danc-
ers (452 female, 125 male) out of a
potential 584 dancers (99%) in the
four groups (Table 1). is included
98 professional and 479 pre-profes-
sional dancers. ose who did not
participate were injured or unavailable
during the screening period. Profes-
sional companies had an equal ratio
of male to female dancers, while pre-
professional programs had a greater
number of females compared to males.
Participants represented a diversity of
ethnic backgrounds, including 44%
African-American, 40% Caucasian,
9% Hispanics, 4% Asian, and less
than 1% Native American, African,
Middle Eastern, and Caribbean.
Professional dancers spent 7.5 hrs/
wk in technique class. e remainder
of their time was spent either in re-
hearsal or performance (30 hrs/wk).
In contrast, pre-professional dancers
spent 21 (BFA-1) and 16.5 (BFA-2)
hrs/wk, respectively, in technique
classes. Both pre-professional semes-
ters culminated in two performances
at the end of the fall and spring, with
approximately 3.0 to 6.0 hrs/wk of
rehearsal.
There were differences between
groups in age (p < 0.001) but not
gender. Post hoc analysis revealed
Prof-Sr dancers were older than Prof-
Jr dancers, followed by BFA-2 and
BFA-1 (p ≤ 0.009). ere were no
dierences between groups in height
or mass, but there were dierences
between genders, with males greater
than females for height (p < 0.001)
and mass (p < 0.001).
There were differences between
groups in years of dance training (p <
0.001). Prof-Sr dancers had a greater
number of years of dance training than
Prof-Jr dancers, BFA-1, and BFA-2 (p
< 0.001); Prof-Jr had more dance
training than BFA-2 (p = 0.014).
ere were no dierences in years of
training between the pre-professional
groups, BFA-1 and BFA-2. ere were
also dierences between genders in
years of dance training: females greater
than males (p < 0.001).
Of the dancers who answered the
relevant questions, there were no dif-
ferences in smoking (9%) or asthma
rates (14%) between groups or gen-
ders (Table 2). Forty-three percent
of dancers said that they performed
cross training activities regularly (1
to 4 times per week for the past year),
with no dierences between groups or
genders. irty-six percent of dancers
said they performed aerobic training.
ere were dierences between groups
in aerobic training (p = 0.014) but no
dierences between genders. Post hoc
analysis found no dierences.
Mean BP was 114/71 mm Hg
(Table 3). ere was a dierence be-
tween groups and genders in systolic
BP (p < 0.001) but not in diastolic
BP. Females systolic BPs were lower
than males. Post hoc, Prof-Sr, and
Prof-Jr dancers systolic BPs were lower
than BFA-1 (p ≤ 0.002). ere were
also dierences between groups in
HRrest (p < 0.001). Post hoc, Prof-Sr,
and Prof-Jr dancers mean HRrest was
lower than that of BFA-1 and BFA-2
dancers (p < 0.001), and BFA-1 was
lower than BFA-2 (p < 0.001). ere
were no dierences between genders
in HRrest.
14
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
Aerobic Fitness
Mean HRpeak was 150 ± 18 beats·min-1
(range 99 to 201 beats·min-1), with
differences between groups (p <
0.001). Post hoc, Prof-Sr, and Prof-Jr
dancers HRpeak was lower than that
of BFA-1 and BFA-2 (p < 0.001),
and BFA-1 was lower than BFA-2 (p
= 0.004). ere was also a gender dif-
ference, with HRpeak lower in males
compared to females (p < 0.001).
HRrecov followed a similar pattern,
with dierences between groups (p <
0.001). Post hoc, Prof-Sr, and Prof-Jr
dancers mean HRrecov was lower than
that of BFA-1 and BFA-2 (p < 0.001),
and BFA-1 was lower than BFA-2 (p =
0.004). is pattern was also reected
in the dierences between groups in
tness ratings (p < 0.001). Post hoc,
Prof-Sr, and Prof-Jr dancers tness rat-
ings (more t) exceeded those of BFA-
1 and BFA-2 dancers (p < 0.001), and
BFA-1 tness ratings exceeded those
of BFA-2 (p < 0.001). ere were no
dierences between genders in HRre-
cov or tness ratings.
Table 2 Group Demographics: Part II
Group Gender Smoking Asthma Cross
Training Aerobic (%)*
Prof-Sr Female 2 (10%) 6 (30%) 7 (70%) 5 (56%)
Male 5 (29%) 3 (18%) 6 (60%) 6 (60%)
Total 7 (19%) 9 (24%) 13 (67%) 12 (60%)
Prof-Jr Female 2 ( 7%) 7 (23%) 7 (50%) 5 (36%)
Male 4 (13%) 3 (10%) 8 (53%) 4 (27%)
Total 6 (10%) 10 (17%) 15 (50%) 9 (30%)
BFA-1 Female 25 (8%) 41 (12%) 134 (42%) 115 (36%)
Male 3 (4%) 13 (19%) 20 (32%) 14 (22%)
Total 28 (7%) 54 (13%) 154 (40%) 129 (34%)
BFA-2 Female 10 (15%) 5 ( 7%) 28 (42%) 25 (37%)
Male 1 (11%) 4 (44%) 5 (50%) 5 (56%)
Total 11 (14%) 9 (13%) 33 (44%) 30 (39%)
Total Female 39 ( 9%) 59 (13%) 176 (43%) 150 (37%)
Male 13 (10%) 23 (18%) 39 (40%) 29 (30%)
Total 52 ( 9%) 82 (14%) 217 (43%) 179 (36%)
*ere were dierences between groups in aerobic training [F(3,514) = 3.588, p = 0.014].
Abbreviations: Number of positive responses out of total, % smoking, % asthma, % cross
training, and % aerobic training, aerobic; Prof-Sr; junior professional company, Prof-Jr;
Bachelors of Fine Arts program #1, BFA-1; Bachelors of Fine Arts program #2, BFA-2.
Table 1 Group Demographics: Part 1
Group Gender Age (years)* Height (m)† Mass (kg)§ BMI Training
(years)|| Prof (years)
Prof-Sr 20 F 27.35 ± 3.83 1.66 ± 0.06 55.08 ± 3.52 19.98 ± 1.36 19.85 ± 6.11 7.35 ± 3.69
18 M 26.67 ± 3.48 1.80 ± 0.06 75.48 ± 5.14 23.27 ± 1.33 14.44 ± 4.06 8.39 ± .05
38 Total 27.03 ± 3.64 1.73 ± 0.09 64.75 ± 11.18 21.54 ± 2.13 17.29 ± 5.85 7.84 ± 3.85
Prof-Jr 30 F 21.17 ± 1.56 1.65 ± 0.05 54.39 ± 5.19 19.97 ± 1.43 13.83 ± 5.11 1.07 ± 0.98
30 M 21.63 ±1.79 1.77 ± 0.07 70.46 ± 8.67 22.37 ± 2.20 10.73 ± 3.42 0.93 ± 0.78
60 Total 21.40 ± 1.68 1.71 ± 0.09 62.43 ± 10.76 21.17 ± 2.13 12.28 ± 4.58 1.00 ± 0.88
BFA-1 333 F 18.02 ± 0.85 1.65 ± 0.08 56.09 ± 5.58 20.68 ± 1.99 11.72 ± 3.38 0 ± 0
65 M 18.33 ± 1.00 1.76 ± 0.05 68.82 ± 6.27 22.16 ± 2.20 7.10 ± 4.11 0 ± 0
401 Total 18.07 ± 0.87 1.67 ± 0.08 58.33 ± 7.49 21.43 ± 1.99 10.91 ± 3.93 0 ± 0
BFA-2 69 F 19.16 ± 3.12 1.62 ± 0.06 58.65 ± 8.58 22.27 ± 2.49 10.62 ± 4.80 0 ± 0
9 M 19.22 ± 1.20 1.77 ± 0.06 67.48 ± 7.11 21.62 ± 1.91 5.89 ± 5.21 0 ± 0
78 Total 19.17 ± 2.96 1.64 ± 0.08 59.67 ± 8.85 22.20 ± 2.43 10.07 ± 5.04 0 ± 0
Total 452 F 18.82 ± 2.62 1.64 ± 0.07 56.35 ± 6.12 20.85 ± 2.10 12.06 ± 4.30 0.39 ±1 .72
125 M 20.35 ± 3.39 1.77 ± 0.06 70.06 ± 7.15 22.33 ± 1.73 8.91 ± 4.85 1.41 ± 3.26
577 All 19.17 ± 2.88 1.67 ± 0.09 59.37 ± 8.52 21.17 ± 2.11 11.36 ± 4.61 0.62 ± 2.19
Abbreviations: years, years; body mass index, BMI; training, dance training; professional experience, prof; senior professional company, Prof-Sr;
junior professional company, Prof-Jr; Bachelors of Fine Arts program #1, BFA-1; Bachelors of Fine Arts program #2, BFA-2; female, F; male,
M. *Dierences between groups in age [F(3,569) = 319.6527, p < 0.001]. Post hoc Prof-Sr versus Prof-Jr, BFA-1, BFA-2, p < 0.001; Prof-Jr
versus BFA-1, BFA-2, p < 0.001; BFA-1 versus BFA-2, p = 0.009. Gender: no dierences. Dierences between genders in height [F(1,569 =
177.303, p < 0.001)]. Dierences between genders in mass [F(1,569 = 275.7028, p < 0.001)]. ||Dierences between groups in years of dance
training [F(3,566) = 49.382, p < 0.001]. Post hoc Prof-Sr versus Prof-Jr, BFA-1, and BFA-2, p < 0.001; Post hoc Prof-Jr versus BFA-2, p = 0.014.
Dierences between genders in years of dance training [F(1,566) = 65.279, p < 0.001].
[Author: Table 1 in “Mass (kg)” column there is a “§” however there is no
corresponding footnote for that symbol. Should it be deleted?]
15
Journal of Dance Medicine & Science • Volume 20, Number 1, 2016
Resting HR was strongly correlated
to HRrecov (r = 0.61, p < 0.001), t-
ness rating (r = 0.58, p < 0.001), and
HRpeak (r = 0.70, p < 0.001). HRpeak
was highly correlated to HRrecov (r =
0.70, p < 0.001) and tness rating (p
= 0.62, p < 0.001), and HRrecov was
highly correlated to tness rating (r =
0.94, p < 0.001). Age demonstrated a
weak negative correlation to HRrecov
(r = -0.220, p < 0.001), but there was
no relationship between BMI or BP
and HRrecov.
Changes Over Time
Seventy-two dancers from the four
groups were screened over 3 years
(Table 4). ere were changes in sys-
tolic BP between groups (p = 0.001).
Systolic BP in Prof-Sr was lower than
that of BFA-1 and BFA-2 dancers
(post hoc Prof-Sr versus BFA-1, p
= 0.017, Prof-Sr versus BFA-2, p <
0.001). ere were dierences across
the 3 years (p = 0.044; pairwise
comparisons year 1 versus year 2, p
= 0.004, and year 1 versus year 3, p
= 0.044), with systolic BP lowering
over the 4 years, and a group-by-time
interaction (p = 0.002). ere were no
dierences between groups in diastolic
BP, but there were dierences due to
time (p = 0.005; pairwise comparisons
year 1 versus year 2, p = 0.003; year 2
versus year 3, p = 0.028).
ere were dierences due to group
in HRrest (p < 0.001; pairwise com-
parisons BFA-2 dancers versus Prof-Sr
and Prof-Jr, p ≤ 0.007) and HRpeak (p
< 0.001; pairwise comparisons BFA-2
dancers versus Prof-Sr and Prof-Jr, p
≤ 0.012), but not time. ere were
dierences in HRrecov between groups
(p < 0.001, pairwise comparisons
Prof-Sr, Prof-Jr, BFA-1 vs. BFA-2, p <
0.001), and time (p = 0.023), with an
interaction between time and group (p
= 0.006). HRrecov in BFA-2 dancers
improved over time, declining over
the 3 years (pairwise comparisons
BFA-2 dancers versus other groups p
< 0.001). Dierences in tness ratings
were also found between groups (p <
0.001, pairwise comparisons Prof-
Sr, Prof-Jr, BFA-1 versus BFA-2, p
< 0.001), time (p = 0.001, pairwise
comparisons year 1 versus year 2 and
year 3, p = 0.004), with an interaction
between time and group (p = 0.001).
Overall tness ratings improved over
time (p < 0.001). While the aerobic
tness of Prof-Sr and Prof-Jr remained
higher than that of the BFA danc-
ers, change over time was seen in
the BFA-2 dancers compared to the
other groups (p < 0.001), improving
consistently over the 3 years.
Twenty dancers from the BFA-2
group were screened consecutively over
Table 3 Mean ± SD for Blood Pressure, Heart Rate, and Fitness Variables
BP HRrest HRpeak HRrecovery Fitness||
Group Gender (mm/Hg)* (beats·min-1)† (beats·min-1)‡ (beats·min-1)§
Prof-Sr Female 103/66 67 ± 9 140 ± 10 82 ± 15 0.60 ± 0.94
Male 113/76 69 ± 11 132 ± 16 85 ± 15 1.22 ± 1.11
Total 107/71 68 ± 10 136 ± 13 83 ± 15 0.89 ± 1.06
Prof-Jr Female 107/67 69 ± 8 141 ± 13 85 ± 13 0.80 ± 0.85
Male 117/76 71 ± 11 132 ± 15 84 ± 12 1.07 ± 0.94
Total 112/72 71 ± 10 136 ± 14 84 ± 12 0.93 ± 0.90
BFA-1 Female 112/70 79 ± 14 153 ± 16 103 ± 20 2.17 ± 1.70
Male 128/74 80 ± 13 145 ± 17 103 ± 19 2.91 ± 1.97
Total 114/71 79 ± 14 152 ± 17 103 ± 20 2.30 ± 1.78
BFA-2 Female 113/69 81 ± 13 162 ± 18 124 ± 23 3.84 ± 1.85
Male 116/70 84 ± 14 141 ± 17 109 ± 21 3.33 ± 1.87
Total 113/69 81 ± 13 160 ± 19 122 ± 23 3.77 ± 1.84
Total Female 111/70 78 ± 14 153 ± 17 104 ± 23 2.26 ± 1.86
Male 123/74 77 ± 13 139 ± 17 95 ± 19 2.20 ± 1.86
All 114/71 77 ± 13 150 ± 18 102 ± 22 2.25 ± 1.86
Abbreviations: blood pressure, BP; heart rate, HR; resting HR, HRrest ; peak HR, HRpeak; 1-min recovery HR, HRrecovery, tness rating, Fitness.
Fitness ratings were determined by HRrecov, gender, and age range and were comprised of 0-7 groupings.23,24 Prof-Sr; junior professional company,
Prof-Jr; Bachelors of Fine Arts program #1, BFA-1; Bachelors of Fine Arts program #2, BFA-2. *Dierences between groups in systolic
BP [F(3,558) = 11.748, p < 0.001]. Post hoc, Prof-Sr and Prof-Jr dancers systolic BP were lower than BFA-1 (p ≤ 0.002); dierences between
genders in systolic BP F(1,558) = 27.208, p < 0.001]. †Dierences between groups in HRrest [F(3,453) = 13.942, p < 0.001]; post hoc Prof-Sr
and Prof-Jr dancers versus BFA-1 and BFA-2 dancers, p < 0.001; BFA versus BFA-2, p < 0.001; there were no dierences between genders in
HRrest. Dierences between groups in HRpeak [F(3,453) = 14.947, p < 0.001]; post hoc Prof-Sr and Prof-Jr dancers versus BFA-1 and BFA-2,
p < 0.001; BFA-1 vs. BFA-2, p = 0.004. dierences between genders in HRpeak [F(3,455) = 25.733, p < 0.001]. §Dierences between groups
in HRrecov [F(3,455) = 30.799, p < 0.001]; post hoc Prof-Sr and Prof-Jr dancers versus BFA-1 and BFA-2, p < 0.001; BFA-1 versus BFA-2, p =
0.004; there were no dierences between genders in HRrecov. ||Dierences between groups in tness categories [F(3,453) = 28.687, p < 0.001];
post hoc Prof-Sr and Prof-Jr versus BFA-1 and BFA-2, p < 0.001; BFA-1 versus BFA-2, p < 0.001; there were no dierences between genders in
tness categories.
16
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
4 years (Table 4). ere were consistent
decreases in HRrecov (p < 0.001, pair-
wise comparisons year 1 versus years 2,
3, and 4, p ≤ 0.021) and improvement
in tness ratings (p = 0.001, pairwise
comparisons year 1 versus years 2, 3,
4, p ≤ 0.006) over the 4 years.
Discussion
Professional dancers exhibited lower
HRrest, HRpeak, HRrecov, and bet-
ter tness ratings compared to pre-
professional dancers. Fitness ratings
did not change from year to year in
professional dancers, but improved
over time in pre-professional dancers.
Correlations of HR variables, tness
ratings, age, BP, and BMI found posi-
tive relationships between HRrecov,
HRpeak, HRrest, and tness ratings,
and a negative relationship between
HRrecov and age, but no relationship
between HRrecov and BMI.
Professional and Pre-Professional
Demographic Characteristics
e dierences between groups in age
and years of dance training but not
in height, mass, or BMI were to be
expected. ere were no dierences
in years of training between the pre-
professional groups, BFA-1, and BFA-
2. erefore, baseline characteristics of
pre-professional dancers did not dier.
Similar rates of smoking and
asthma were reported among groups.
While the rate of smoking found in
the Prof-Sr in this study is higher than
previously reported for this company,21
this project reects data collected from
Prof-Sr from 2006 to 2012. Current
rates in a recent single screening year
Table 4 Mean ±SD Change in Aerobic Fitness
Group # Subjects BP
(mm Hg)* HRrest
(beats min-1)
HRpeak
(beats·min-1)
HRrecovery
(beats·min-1)§ Fitness||
Year 1
Prof-Sr 15 108/73 70 ± 7 133 ± 12 81 ± 13 0.73 ± 0.88
Prof-Jr 6 111/72 67± 4 135 ± 11 74 ± 8 0.33 ± 0.51
BFA-1 13 123/74 83 ± 16 156 ± 12 105 ± 25 3.23 ± 2.27
BFA-2 38 115/69 84 ± 14 164 ± 17 126 ± 23 4.16 ± 1.73
Total 72 115/71 80 ± 14 153 ± 20 108 ± 29 2.96 ± 2.24
Year 2
Prof-Sr 15 101/61 68 ± 8 131 ± 13 79 ± 11 0.67 ± 0.82
Prof-Jr 6 99/52 70 ± 8 149 ± 16 85 ± 15 0.47 ± 0.92
BFA-1 13 108/67 74 ± 8 142 ± 7 89 ± 10 1.23 ± 1.09
BFA-2 38 116/70 80 ± 14 159 ± 18 120 ± 21 3.61 ± 1.67
Total 72 110/67 75 ± 13 149 ± 19 103 ± 25 2.28 ± 1.98
Year 3
Prof-Sr 15 114/77 68 ± 8 131 ± 13 79 ± 11 0.47 ± 0.92
Prof-Jr 6 104/72 68 ± 11 143 ± 13 83 ± 12 0.83 ± 0.98
BFA-1 13 112/71 73 ± 11 144 ± 8 87 ± 11 1.08 ± 1.19
BFA-2 38 111/69 83 ± 15 155 ± 16 114 ± 20 3.24 ± 1.70
Total 72 110/69 77 ± 14 146 ± 17 99 ± 23 2.07 ± 1.89
Year 4
BFA-2 38 116/71 78 ± 14 153 ± 14 109 ± 22 2.09 ± 1.94
Abbreviations: blood pressure, BP; heart rate, HR; resting HR, HRrest; peak HR, HRpeak; 1-min recovery HR, HRrecovery, tness category,
Fitness. Prof-Sr; junior professional company, Prof-Jr; Bachelors of Fine Arts program #1, BFA-1; Bachelors of Fine Arts program #2, BFA-2.
* Dierences in systolic BP between groups [F(3,56) = 6.021, p = 0.001]; post hoc Prof-Sr versus BFA-1, p=0.017, Prof-Sr versus and BFA-2,
p < 0.001; dierences in systolic BP due to time [F(1,56) = 4.261, p = 0.044]; post hoc pairwise comparisons year 1 versus year 2, p = 0.004,
and year 1 versus year 3, p = 0.044; interaction between group and time [F(3,56) = 5.398, p = 0.002]. *Dierences in diastolic BP due to time
[F(1,56) = 8.546, p = 0.005]; post hoc pairwise comparisons year 1 versus year 2, p=0.003; year 2 versud year 3, p = 0.028; no dierences between
groups in diastolic BP. †Dierences in HRrest between groups [F(3,68) = 10.276, p < 0.001]; post hoc pairwise comparisons BFA-2 dancers
versus Prof-Sr and Prof-Jr, p ≤ 0.007; no dierences due to time. ‡Dierences in HRpeak between groups [F(3,60) = 17.839, p < 0.001]; post
hoc pairwise comparisons BFA-2 dancers versus Prof-Sr and Prof-Jr, p ≤ 0.012; no dierences due to time. § Dierences in HRrecov between
groups [F(3,68) = 31.414, p < 0.001]; post hoc pairwise comparisons Prof-Sr, Prof-Jr, BFA-1 v BFA-2, p < 0.001; dierences in HRrecov due
to time [F(1,71) = 5.436, p = 0.023], Interaction between time and group [F(3,68) = 4.472, p = 0.006]. ||Dierences in Fitness between groups
[F(3,68) = 26.773, p < 0.001]; post hoc pairwise comparisons Prof-Sr, Prof-Jr, BFA-1 v BFA-2, p < 0.001; dierences in Fitness due to time
[F(1,68) = 11.259, p=0.001]; post hoc pairwise comparisons year 1 versus year 2 and year 3, p = 0.004; interaction between time and group
[F(3,68) = 5.980, p = 0.001]. Four year analysis of BFA-2: dierences in HRrecov over time [F(1,19) = 23.818, p < 0.001]; post hoc pairwise
comparisons year 1 versus years 2, 3, and 4, p ≤ 0.021; dierences in tness category over time [F(1,19) = 15.035, p = 0.001]; post hoc pairwise
comparisons year 1 versus years 2, 3, 4, p ≤ 0.006.
17
Journal of Dance Medicine & Science • Volume 20, Number 1, 2016
are more in line with those previously
reported.21 According to the Center
for Disease Control and Prevention,
19% of adults in the USA report
smoking.26 Although the overall rate
of 9% in this study is lower than the
national average, smoking cessation
support remains an important issue
to promote among all dancers. Studies
report increased fatigue and decreased
VO2 max in smokers compared to
non-smokers.27,28 In 2013 Center
for Disease Control and Prevention
surveillance data, asthma prevalence
was 7% of US adults, 6.2% males
and 8.3% females, 9.9% blacks, 7.4%
whites, and 5.9% Hispanics (N.B.:
the CDC reports ethnicity dierently
than we do here).29 In a recent review,
7 to 8% of Olympic athletes suered
from exercise-induced asthma.30 e
asthma rate of 14% in this study was
higher than both these reports. is
may be explained by several factors,
including the higher prevalence of
asthma in black Americans (almost
half of our population were African
Americans) and the lower asthmatic
stressors induced by dance training
compared to endurance sports. It is
thought that intense training regimens
with the added factors of training
outdoors in the cold, exposure to
particulate matter, exposure to chlora-
mines in the case of swimmers or other
poor quality air, produce a progressive
process of exercise-induced airway
hyper-responsiveness and asthma.30 It
may be that individuals with asthma
are relatively more successful in dance,
which is usually practiced indoors,
compared to endurance sport athletes
who are exposed to these other factors.
Systolic BP differed between
groups and genders but not diastolic
BP, and all BP results were within
normal ranges. While lower BP has
been found to be associated with lower
resting HR and aerobic tness,31 we
did not nd this relationship.
Professional and Pre-Professional
Aerobic Fitness
Aerobic training is an important de-
terminant of maximal oxygen uptake
(VO2 max) as well as related HR vari-
ables.32 Both HRrest and HRrecov are
risk factors for overall mortality.31,33
Therefore, aerobic fitness becomes
important not only as a factor in
fatigue-related injury but for lifelong
health. The fast phase of recovery
following high intensity intermittent
exercise includes a rapid decline in
both VO2 and HR.34 e ability to
recover quickly is critical in dance per-
formance, which may require repeated
episodes of high intensity dancing.
Both professional groups exhib-
ited enhanced aerobic tness, based
on their HRrecov, compared to pre-
professional dancers. Overall, pro-
fessional dancers spent a great deal
more time dancing, whether in class,
rehearsal, or performance, compared
to pre-professional students; and more
Sr-Prof dancers performed cross train-
ing and aerobic training activities in
comparison to the other groups. In a
previous comparison of professional
modern and ballet companies using
the accelerated step test, modern
dancers demonstrated enhanced
aerobic tness compared to their bal-
let counterparts.21 is dierence was
also found in previous studies using
VO2max tests of aerobic fitness in
professional ballet and modern danc-
ers.22,35-40 (N. B.: we did not include
the research reporting on aerobic
fitness in contemporary dancers.
Although modern and contemporary
dance have common roots, it is not
clear whether the current dance train-
ing and performance requirements of
modern and contemporary dancers
are the same.)
Age was negatively correlated to
HRrecov: meaning that older dancers
tended to have improved HRrecov.
is is an unusual nding, as generally
tness declines and HRrecov is slowed
with aging. However, comparisons of
trained younger (in their 20’s) and
older athletes (in their 50’s) found
no dierences in HRrecov.41 e age
range of the dancers in the current
study was a continuum of 18 to 35
years; therefore, the negative relation-
ship between age and HRrecov may
be more reective of the demands of
professional dance.
A review of VO2max in dancers
indicates that female dancers typically
exhibit a range of 39 to 54 and males
45 to 67 ml·kg-1·min-1 values. e
greatest focus to date has been on as-
sessing VO2 max in professional ballet
dancers (females 39 to 53, males 46 to
59 ml·kg-1·min-1).18,35-38,42,43 Less well
studied are modern and other dance
forms in professional or university
level dancers. A summary of VO2
max findings includes professional
modern (females 49 to 52 and males
67 ml·kg-1·min-1),22,39 professional
contemporary (46 ml·kg-1·min-1),44
professional jazz (females 42, males 49
ml·kg-1·min-1),45 professional com-
petitive ballroom (females 42 to 54,
males 53 to 61 ml·kg-1·min-1),46-48
university ballet (females 41 to 47
ml·kg-1·min-1),39,49 and university
modern dancers (females 39 to 51,
combined females and males 51
ml·kg-1·min-1).22,49-51 is summary
suggests that female modern danc-
ers exhibit values similar to those
of professional ballet and ballroom
dancers, and male modern dancers
exhibit higher values than their ballet
and ballroom counterparts.
Comparisons of VO2max in profes-
sional and pre-professional modern
dancers found no dierences in one
study.52 However, in a second study,
increased VO2max suggested higher
aerobic tness in female professional
modern dancers compared to pre-
professional students.39 While this
study did not investigate VO2max, our
ndings of enhanced aerobic tness
(based on HRrecov and tness ratings)
in the professional compared to pre-
professional dancers support the nd-
ings of Chlemar and coworkers.39 We
also found dierences in HRrecov and
tness ratings between pre-profession-
al groups. BFA-1 dancers had greater
aerobic tness compared to BFA-2
dancers. Demographic characteristics
were similar between the two groups.
While we are unable to identify the
reason for this dierence, one program
is considered to be more demanding,
with a dicult audition process for
entry, than the other. It may be that
students entered BFA-1 with a higher
pre-existing baseline of tness and
skill-based training. By the second
year of screening, all pre-professional
students were undergoing relatively
similar dance training; however, in
addition, BFA-2 had weekly supple-
18
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
mental wellness classes. is may ac-
count for some of the improvement
in tness measures seen in BFA-2 over
subsequent years.
e aerobic capacity of dancers is
generally lower than other athletes and
similar to active age-matched individ-
uals.49 While dance performance has
been categorized as a high intensity
intermittent exercise activity,53,54 the
cardiorespiratory response to modern
dance and ballet technique classes is
considered insucient to promote
the aerobic adaptation sought in
higher levels of aerobic tness.54,55
Monitoring of dance class, rehearsal,
and performance in both professional
and pre-professional contemporary
dancers found performance required
signicantly greater HR and oxygen
consumption,54 pointing to a need
for supplemental training. Our results
suggest there is a need for supplemen-
tal training in modern dancers as well.
Changes Over Time in Aerobic
Fitness
All the groups we tested had access to
aerobic and tness equipment. When
results of the screen were reviewed
with each participant, the importance
of supplemental training was always
emphasized. In particular, dancers
were counseled to add supplemental
aerobic training if their tness ratings
were from 3 to 7.
We analyzed change in tness vari-
ables over time in a subset of groups
that underwent annual screening.
e professionals’ HRrecov and t-
ness remained stable over time. Only
one group, BFA-2, demonstrated
improvements in HRrecov and tness.
ere are several explanations for this
nding. First, both groups of profes-
sional dancers spend more hours per
week dancing than both groups of
pre-professional dancers. Second,
based on their annual rehearsal and
performance schedule, it is likely that
Prof-Sr maintained a relatively steady
state of tness. Annually, there is only
one long vacation break of 3 weeks
following a rigorous New York season.
All other breaks are 1 to 2 weeks in
length. e Prof-Jr group had more
time o, but the amount of danc-
ing in which they participated may
have been more rigorous, as there are
only 12 dancers who perform in the
majority of the repertory. In contrast,
the pre-professional dancers were not
in school all summer (approximately
16 weeks), and it is up to them to
take technique classes and maintain
their tness. ird, it is possible that
there was insucient opportunity for
pre-professionals to add supplemen-
tal training to their already rigorous
dance and academic class schedule
during the school year. However, the
mandatory wellness class (50 min/wk)
supplemented BFA-2 training. is
may have played an important part
in the tness improvements measured
over 4 years in the BFA-2 group. e
weekly wellness classes emphasized
the practice of sound dance biome-
chanics and developed individualized
strengthening, stretching, and aerobic
programs for each dancer to perform
on their own. In contrast, BFA-1
dancers learned about injury preven-
tion, including the practice of sound
dance biomechanics and principles
of eective aerobic conditioning, in a
single workshop.
HRrecov improves with aerobic
training and is therefore considered
to be a sensitive marker of change
in aerobic tness over time.56 Pre-
professional dancers demonstrated
improvement in aerobic tness over
time. Professionals, while continuing
to demonstrate greater tness, did
not change. Despite dancing fewer
hours/wk compared to BFA-1, only
the BFA-2 dancers demonstrated
signicant improvement compared
to the other groups. erefore, it is
likely that the mandatory wellness
classes were responsible for this dier-
ence. Researchers have demonstrated
improvement in aerobic tness with
supplemental training of varying
lengths from 6 weeks to 1 year in pre-
professional and professional modern
and contemporary dancers17,50,57 as
well as professional ballet dancers,58,59
thus supporting our ndings. In con-
trast, other researchers have reported
no change in aerobic tness in pre-
professional dancers with a 4-month
conditioning program.60 We may have
seen no change over time in the pro-
fessional dancers as they were main-
taining the aerobic tness required for
their workload, a level that exceeded
that of the pre-professionals.
Preliminary investigations report
that pre-professional ballet dancers
with lower levels of aerobic tness
suer more musculoskeletal injuries
than those with higher levels.14 Several
other studies analyzed injury factors
retrospectively from dance injury
reports and found fatigue to be the
most common variable cited by danc-
ers.12-14 Prospective studies of military
trainees found that lower aerobic
fitness is related to increased risk
for musculoskeletal injury.61 Greater
cardiorespiratory tness might serve
to reduce the eects of fatigue; how-
ever, a clear relationship remains to be
demonstrated for dance.
Supplemental Training
Recommendations for
Pre-Professional Dancers
It is now well established that dance
technique classes by themselves do
not suciently challenge the aerobic
and anaerobic systems to attain the
fitness level necessary for perfor-
mance.44,53,54,62 Studies suggest that
dance performance requires energy
expenditure up to 85% of VO2 max
and 80-95% of HRmax.37,63,64 Increas-
ingly, recommendations are being
made for dancers to supplement their
dance training with aerobic condi-
tioning.20,53,65 Research suggests that
a combination of high volume low to
moderate intensity (HVL-MI) aerobic
exercise combined with short-term
high intensity interval training (HIIT)
may provide optimal training.66,67
Aerobic exercise includes running,
swimming, cycling, aerobics classes,
or other continuous activities that
result in an increased HR for 20 to 40
minutes. An optimal target training
range is 70 to 90% of HRmax (HRmax
is estimated as 220-age).20,53 To make
improvements, exercise frequency of 3
to 4 times/wk is recommended. When
considering supplemental training to
increase performance, the majority of
focus is on (HVL-MI) aerobic exer-
cise. is provides the platform upon
which to introduce HIIT exercise.
Maintenance programs, when HIIT
activities are introduced or dancers
19
Journal of Dance Medicine & Science • Volume 20, Number 1, 2016
have begun performance, require
HVL-MI training 1 to 2 times per
week.
HIIT involves intermittent exer-
cise at “all-out” or “supra-maximal”
intensity,66 in which participants work
at levels greater than or equal to 90%
to 95% VO2 max or 90% to 95%
HRmax.67 e type of exercise may in-
clude bursts of sprint running, sprint
cycling, jumping, or combinations
thereof. HIIT exercise is comprised of
anywhere from 1:1 to 1:5 ratios of ex-
ercise to active rest (active rest such as
walking or slow jogging is encourage
to promote faster recovery) depending
on the age of the population, level of
training, and type of training. A range
of intervals have been suggested, for
example, from 15 seconds of exercise
and 15 seconds of active rest (1:1
ratio) to 30 seconds of exercise and 2
minutes of active rest (1:4 ratio).66-69
ese bouts of alternating exercise
followed by active rest are repeated up
to 10 times. Generally, based on the
research literature, a limited period
of HIIT exercise is recommended 2
to 4 weeks before the dancer wishes
to reach peak performance levels. A
ratio of 75% HVL-MI aerobic train-
ing to 10 to 15% HIIT activity is
recommended (with less than 10%
devoted to warm up and cool down
low intensity activity). Too much
HIIT exercise, particularly without
adequate recovery, can lead to over-
training and burnout.66,70
Dance performance is comprised
of intermittent periods of varying
lengths that range from low to high
intensity, with some choreography
comprised of greater periods of high
intensity while others may fluctu-
ate between various levels. Intense
exercise performance requires both
aerobic and anaerobic components.
Both types of training, as outlined
above, are important because dierent
adaptations occur depending on the
type of training.
Limitations
Our annual screening does not assess
VO2max due to the number of dancers
that are screened in a relatively short
time and equipment constraints. Al-
though our results report preseason
aerobic tness in dancers, it should
be noted that this estimate is relative
to physical tness criteria and does
not indicate the participant’s level of
skill-related tness.
Heart rate has a positive relation-
ship to energy expenditure during
physical activity and can serve as an
accurate indirect measure to evalu-
ate metabolic demand.71 e 1-min
HRrecov variable represents the fast
recovery phase, with more rapid
recovery indicating individuals with
a higher aerobic capacity.41 VO2max
is not required to estimate aerobic
tness, as HRrecov has demonstrated
a strong relationship with training
in steady state, moderate, and high
intensity exercise, as well as intermit-
tent exercise.34,71-73
Recent research has focused on al-
ternative ways of screening for aerobic
tness in dancers, such as the Dance
Specic Aerobic Fitness Test (DAFT)
for contemporary dancers and a ballet-
specific test.44,74-76 One argument
against using dance-specic tness
tests is that a given test may only
be appropriate for one dance form
(e.g., contemporary dance or ballet),
require a familiarization period, and
can be lengthy (up to 20 min).44,76
While these tests measure maximal
HR, they do not report HRrecov and
therefore cannot be compared with
the results of the accelerated step test.
Furthermore, they do not allow for
comparisons across genres.
Currently, the Dance/USA post-
hire health screen, used to evaluate
the professional modern dancers in
this study, provides only 20 min per
dancer for the assessment of medical
history, vital signs, tness, and other
physiologic measures.1,77 ese tests
are administered onsite in the dance
studio or physical therapy room. e
accelerated step test, requiring a total
of 4-min, is ecient and utilizes mini-
mal, low cost equipment.
As greater numbers of dancers at
all levels of training are screened, we
will be able to establish norms for
various parameters. In the future, this
will enable researchers, dance faculty,
healthcare providers, and company
artistic sta to establish best practice
to optimize training and conditioning
for dancers of all ages.
Conclusion
e ability to conduct large studies
on dancers is limited. Here, we report
screening results from the largest
group of professional and pre-profes-
sional modern dancers tested to date
in the USA. Screening programs will
not by themselves decrease injuries; it
is through the information gathered
from screening that change may be
studied and implemented. Dierences
between pre-professional and profes-
sional dancer aerobic tness suggest
it remains particularly important to
emphasize aerobic training at the pre-
professional level as preparation for
the demands of professional careers.
If we classify dance as having compo-
nents of high-intensity intermittent
exercise, aerobic fitness enhances
recovery from these recurrent periods.
e ability to recover quickly is criti-
cal to enable optimal performance in
subsequent choreographic sequences.
Greater aerobic conditioning during
pre-professional training is impera-
tive to meet the increasing demands
of choreography at the professional
level. Future study of the relationship
between aerobic tness and imple-
mentation of more stringent training
programs on the incidence of injury
is necessary.
Practical Implications
Professional modern dancers dis-
play greater aerobic tness than
pre-professional dancers.
Supplemental aerobic training is
recommended for pre-professional
modern dance students to prepare
themselves for the demands of a
professional career.
Wellness programs that include
aerobic exercise appear to be eec-
tive in improving aerobic tness in
pre-professional dancers.
References
1. Southwick H, Gibbs R, Bronner
S, Cassella M. Update on the an-
nual post-hire health screen for
professional dancers: Dance/USA
Taskforce on Dancer Health. Pre-
sented at: XVIII Annual Meeting
of International Association for
20
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
Dance Medicine & Science 2008.
Cleveland, OH: IADMS, 2008.
2. Klossner D. National Collegiate
Athletic Association. 2013-14
NCAA Sports Medicine Handbook
(24th ed). Indianapolis, IN: Nation-
al Collegiate Athletic Association,
2013. Available at: www.ncaa.org/
sites/default/les/2013-14 Sports
Medicine Handbook.pdf.
3. Fuller M, Peirce D. Screening
practices in dance: applying the
research. Presented at: Dance
Dialogues: Conversations across
Cultures, Artforms and Practices.
Brisbane, Australia, 2008.
4. Gamboa JM, Roberts LA, Maring
J, Fergus A. Injury patterns in elite
preprofessional ballet dancers and
the utility of screening programs
to identify risk characteristics. J
Orthop Sports Phys Ther. 2008
Mar;38(3):126-36.
5. Molnar M, Esterson J. Screen-
ing students in a pre-professional
ballet school. J Dance Med Sci.
1997;1:118-21.
6. Southwick H, Cassella M. Boston
ballet student screening clinic: an
aid to injury prevention. Orthop
Phys Ther Practice. 2002;14:14-6.
7. Department of Performing Arts
LIUB. Dance Wellness. Available
at: www.liu.edu/Brooklyn/Aca-
demics/Schools/CLAS/Programs/
Div4/PA/Dance2/Dance-Wellness.
Accessed September 14, 2014,
2014.
8. Department of Dance Case Western
Reserve. Dancer Wellness Program.
dance.case.edu/dancer-wellness-
program/. Accessed February 23,
2015.
9. Texas A&M Dance Program.
Dancer Wellness Clinic. dance.
tamu.edu/about/dance-wellness.
Accessed Febrary 23, 2015.
10. Clark T, Gupta A, Ho CH. Develop-
ing a dancer wellness program em-
ploying developmental evaluation.
Front Psychol. 2014 Jul 10;5:731.
11. Deprati E, Iosa M, Haggard P. A
dance to the music of time: aes-
thetically-relevant changes in body
posture in performing art. PlosOne.
2009;4(3):e5023.
12. Laws H. Fit to Dance 2—Report of
the Second National Inquiry Into
Dancers’ Health and Injury in the
UK. London, UK: Dance UK, 2005.
13. Liederbach M, Compagno J. Physi-
ological aspects of fatigue-related
injuries in dancers. J Dance Med
Sci. 2001;5:116-20.
14. Twitchett E, Brodrick A, Nevill
AM, et al. Does physical tness
aect injury occurrence and time
loss due to injury in elite vocational
ballet students? J Dance Med Sci.
2010;14(1):26-31.
15. Angioi M, Metsios GS, Koutedakis
Y, et al. Physical tness and sever-
ity of injuries in contemporary
dance. Med Probl Perform Art.
2009;24:26-9.
16. Angioi M, Metsios GS, Koutedakis
Y, Wyon MA. Fitness in contempo-
rary dance: a systematic review. Int
J Sports Med. 2009 Jul;30(7):475-
84.
17. Angioi M, Metsios GS, Twitchett
EA, et al. Eects of supplemental
training on fitness and aesthetic
competence parameters in contem-
porary dance. Med Probl Perform
Art. 2012 Mar;27(1):3-8.
18. Brinson P, Dick F. Fit to Dance?
London: Calouse Gulbenkian
Foundation, 1996.
19. Redding E, Wyon M, Shearman J,
Doggart L. Validity of using heart
rate as a predictor of oxygen con-
sumption in dance. J Dance Med
Sci. 2004;8:69-72.
20. Wyon MA. Cardiorespiratory train-
ing for dancers. J Dance Med Sci.
2005;9:7-12.
21. Bronner S, Ojofeitimi S, Bailey
Lora J, et al. A preseason cardio-
respiratory profile of dancers in
nine professional ballet and mod-
ern companies. J Dance Med Sci.
2014;18:72-81.
22. Bronner S, Rakov S. An accelerated
step test to assess dancer preseason
aerobic tness. J Dance Med Sci.
2014;18:12-21.
23. American College of Sports Medi-
cine. ACSM’s Guidelines for Ex-
ercise Testing and Prescription
(8th ed). Philadelphia: Lippincott
Williams & Wilkins, 2009.
24. Golding L, Myers C, Sinning WE.
The YMCA Physical Fitness Test
Battery. Y’s Way to Physical Fitness
(4th ed). Champaign, IL: Human
Kinetics, 1989, pp. 61-138.
25. Gibbs R, Bronner S, Cassella M, et
al. Annual Post-Hire Health Screen
for Professional Dancers Guide-
lines. 2006. Available at: Available
at: www2.danceusa.org/uploads/
Dancer_Health/resources_Health-
ScreenGuidelines.pdf.
26. Schiller JS, Lucas JW, Peregory JA.
Summary Health Statistics for U.S.
Adults: National Health Interview
Survey. Washington, DC: PUB-
LISHER NAME, 2012.
27. Klausen K, Andersen C, Nandrup S.
Acute eects of cigarette smoking
and inhalation of carbon monox-
ide during maximal exercise. Eur
J Appl Physiol Occup Physiol.
1983;51(3):371-9.
28. Lee C-L, Chang W-D. The eects
of cigarette smoking on aerobic and
anaerobic capacity and heart rate
variability among female university
students. Int J Womens Health.
2013;5:667-79.
29. Asthma surveillance data. US Dept.
of Health and Human Services;
2013. Available at: www.cdc.gov/
asthma/asthmadata.htm. Accessed
February 26, 2015.
30. Kippelen P, Fitch KD, Anderson
SD, et al. Respiratory health of elite
athletes - preventing airway injury:
a critical review. Br J Sports Med.
2012 Jun;46(7):471-6.
31. Tell GS, Vellar OD. Physical tness,
physical activity, and cardiovascu-
lar disease risk factors in adoles-
cents: The Oslo younth study. Prev
Med. 1988 Jan;17:12-24.
32. Uth N, Sorensen H, Overgaard K,
Pedersen PK. Estimation of VO2max
from the ratio between HRmax
and HRrest—the Heart Rate Ratio
Method. Eur J Appl Physiol. 2004
Jan;91(1):111-15.
33. Watanabe J, amilarasan M, Black-
stone EH, et al. Heart rate recovery
immediately after treadmill exer-
cise and left ventricular systolic
dysfunction as predictors of mor-
tality: the case of stress echocar-
diography. Circulation. 2001 Oct
16;104(16):1911-16.
34. Tomlin DL, Wenger HA. e re-
lationship between aerobic tness
and recovery from high intensity
intermittent exercise. Sports Med.
2001;31(1):1-11.
35. Cohen JL, Segal KR, Witriol I,
McArdle WD. Cardiorespiratory
responses to ballet exercise and the
VO2max of elite ballet dancers. Med
Sci Sports Exerc. 1982;14(3):212-17.
36. Micheli LJ, Gillespie WJ, Walaszek
A. Physiologic profiles of female
professional ballerinas. Clin Sports
Med. 1984 Jan;3(1):199-209.
37. Schantz P, Astrand P. Physiolog-
ic characteristics of classical bal-
Author:
Ref 26 is incomplete. Please provide name of publisher.
21
Journal of Dance Medicine & Science • Volume 20, Number 1, 2016
let. Med Sci Sports Exerc. 1984
Oct;16(5):472-6.
38. Wyon MA, Deighan MA, Nevill AM,
et al. e cardiorespiratory, anthro-
pometric, and performance charac-
teristics of an international/national
touring ballet company. J Strength
Cond Res. 2007 May;21(2):389-93.
39. Chmelar RD, Schultz BB, Ruhling
RO, et al. A physiologic profile
comparing levels and styles of fe-
male dancers. Phys Sportsmed.
1988;16:87-94.
40. Kirkendall DT, Calabrese LH. Physi-
ological aspects of dance. Clin Sports
Med. 1983 Nov;2(3):525-37.
41. Darr KC, Bassett DR, Morgan BJ,
omas DP. Eects of age and train-
ing status on heart rate recovery after
peak exercise. Am J Physiol. 1988
Feb;254(2 Pt 2):H340-3.
42. Mostardi RA, Portereld JA, Green-
berg B, et al. Musculoskeletal and
cardiopulmonary characteristics of
the professional ballet dancer. Phys
Sportsmed. 1983;11:53-61.
43. Rimmer JH, Jay D, Plowman
SA. Physiological characteristics of
trained dancers and intensity level
of ballet class and rehearsal. Impulse.
1994;2:97-105.
44. Redding E, Weller P, Ehrenberg S, et
al. e development of a high inten-
sity dance performance tness test. J
Dance Med Sci. 2009;13(1):3-9.
45. Lavoie JM, Lebe-Neron RM. Physi-
ological eects of training in profes-
sional and recreational jazz dancers.
J Sports Med Phys Fitness. 1982
Jun;22(2):231-6.
46. Kline GM, Porcari JP, Hintermeister
R, et al. Estimation of VO2max from
a one-mile track walk, gender, age,
and body weight. Med Sci Sports
Exerc. 1987 Jun;19(3):253-9.
47. Bria S, Bianco M, Galvani C, et al.
Physiological characteristics of elite
sport-dancers. J Sports Med Phys
Fitness. 2011 Jun;51(2):194-203.
48. Liiv H, Jürimäe T, Mäestu J, et al.
Physiological characteristics of elite
dancers of dierent dance styles. Eur
J Sport Sci. 2014;14 Suppl 1:S429-
36.
49. White SB, Philpot A, Green A, Bem-
ben MG. Physiological comparison
between female university ballet and
modern dance students. J Dance
Med Sci 2004;8:5-10.
50. Koutedakis Y, Hukam H, Metsios
G, et al. e eects of three months
of aerobic and strength training on
selected performance- and tness-
related parameters in modern dance
students. J Strength Cond Res. 2007
Aug;21(3):808-12.
51. Wyon M, Head A, Sharp C, Redding
E. e cardiorespiratory responses
to modern dance classes: dierences
between university, graduate, and
professional classes. J Dance Med
Sci. 2002;6(2):41-5.
52. Chateld SJ, Byrnes WC, Lally DA,
Rowe SE. Cross-sectional physiologic
proling of modern dancers. Dance
Res J. 1990;22:13-20.
53. Raerty S. Considerations for inte-
grating tness into dance training. J
Dance Med Sci. 2010;14:45-9.
54. Wyon MA, Abt G, Redding E, et
al. Oxygen uptake during modern
dance class, rehearsal, and perfor-
mance. J Strength Cond Res. 2004
Aug;18(3):646-9.
55. Cohen JL, Segal KR, Witriol I,
McArdle WD. Cardiorespiratory
responses to ballet exercise and the
VO2max of elite ballet dancers. Med
Sci Sports Exerc. 1982;14(3):212-17.
56. Lamberts RP, Swart J, Noakes TD,
Lambert MI. Changes in heart rate
recovery after high-intensity training
in well-trained cyclists. Eur J Appl
Physiol. 2009 Mar;105(5):705-13.
57. Redding E, Irvine S, Quin E,
Raerty S. Dance science: scien-
tic investigations into the eect of
dance specic tness training and
its impact upon pedagogic practices
and dance performance. Presented
at: International Symposium on
Performance Science. Auckland,
New Zealand, 2009.
58. Smol E, Fredyk A. Supplemen-
tary low-intensity aerobic training
improves aerobic capacity and
does not aect psychomotor per-
formance in professional female
ballet dancers. J Hum Kinet. 2012
Mar;31:79-87.
59. Ramel E, Thorsson O, Wollmer P.
Fitness training and its eect on
musculoskeletal pain in profes-
sional ballet dancers. Scand J Med
Sci Sports. 1997 Oct;7(5):293-8.
60. Roussel NA, Vissers D, Kuppens K,
et al. Eect of a physical condition-
ing versus health promotion inter-
vention in dancers: a randomized
controlled trial. Man Ther. 2014
Dec;19(6):562-8.
61. Lisman P, O’Connor FG, Deuster
PA, Knapik JJ. Functional move-
ment screen and aerobic fitness
predict injuries in military train-
ing. Med Sci Sports Exerc. 2013
Apr;45(4):636-43.
62. Wyon MA, Head A, Sharp NC,
Redding E. The cardiorespiratory
responses to modern dance classes:
differences between university,
graduate, and professional classes.
J Dance Med Sci. 2002;6:41-5.
63. Cohen JL, Segal KR, McArdle WD.
Heart rate response to ballet stage
performance. Phys Sportsmed.
1982;10:120-33.
64. Twitchett EA, Koutedakis Y, Wyon
MA. Physiological fitness and
professional classical ballet perfor-
mance: a brief review. J Strength
Cond Res. 2009 Dec;23(9):2732-
40.
65. Irvine S, Redding E, Raerty S.
Dance tness. IADMS Resource
Paper. Available at: c.ymcdn.com/
sites/www.iadms.org/resource/
resmgr/resource_papers/dance_t-
ness.pdf. Accessed February 23,
2015.
66. Laursen PB. Training for intense
exercise performance: high-intensi-
ty or high-volume training? Scand J
Med Sci Sports. 2010 Oct;20 Suppl
2:1-10.
67. Wislo U, Ellingsen O, Kemi OJ.
High-intensity interval training to
maximize cardiac benets of exer-
cise training? Exerc Sport Sci Rev.
2009 Jul;37(3):139-46.
68. Billat LV. Interval training for per-
formance: a scientic and empirical
practice. Special recommendations
for middle- and long-distance run-
ning. Part II: anaerobic interval train-
ing. Sports Med. 2001 Feb;31(2):75-
90.
69. Tabata I, Nishimura K, Kouzaki M,
et al. Eects of moderate-intensity
endurance and high-intensity inter-
mittent training on anaerobic capac-
ity and VO2max. Med Sci Sports
Exerc. 1996 Oct;28(10):1327-30.
70. Billat VL, Flechet B, Petit B, et al.
Interval training at VO2max: eects
on aerobic performance and over-
training markers. Med Sci Sports
Exerc. 1999 Jan;31(1):156-63.
71. Strath SJ, Swartz AM, Bassett DR
Jr, et al. Evaluation of heart rate
as a method for assessing moder-
ate intensity physical activity. Med
Sci Sports Exerc. 2000 Sep;32(9
Suppl):S465-70.
72. Bernard T, Gavarry O, Bermon S,
et al. Relationships between oxygen
Author:
Ref 26 is incomplete. Please provide name of publisher.
22
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
consumption and heart rate in transi-
tory and steady states of exercise and
during recovery: inuence of type of
exercise. Eur J Appl Physiol Occup
Physiol. 1997;75(2):170-6.
73. Short KR, Sedlock DA. Excess
postexercise oxygen consumption
and recovery rate in trained and
untrained subjects. J Appl Physiol
(1985). 1997 Jul;83(1):153-9.
74. Olson MS, Williford HN, Blessing
DL, et al. A test to estimate VO2max
in females using aerobic dance, heart
rate, BMI, and age. J Sports Med
Phys Fitness. 1995 Sep;35(3):159-
68.
75. Wyon M, Redding E, Abt G, et al.
Development, reliability, and validity
of a multistage dance specic aerobic
tness test (DAFT). J Dance Med
Sci. 2003;7:80-4.
76. Twitchett E, Nevill A, Angioi M,
et al. Development, validity, and
reliability of a ballet-specic aero-
bic tness test. J Dance Med Sci.
2011;15:123-7.
77. Kadel N, Southwick H, Cole HH.
Update on the annual post-hire
health screen for professional danc-
ers: Dance/USA Taskforce on Dancer
Health. Annual Dance USA Con-
ference. Chicago, IL: Dance/USA,
2011.
... 9 This indicates that pre-professional dance training, during which students are primarily exposed to class and rehearsal, may not adequately prepare a dancer for the performance demands of being a professional. It has been shown that professional dancers have better aerobic fitness compared to preprofessional dancers, [31][32] and lesser aerobic fitness levels have been associated with the number of injuries sustained in ballet students. 33 Decreased lower body muscular power has been linked to days lost due to injury in contemporary dance students. ...
... Two studies have indicated that professional dancers have better aerobic fitness than pre-professional dancers. 31,32 This may suggest that professional dancers are exposed to more appropriate training for their work demands. ...
Article
This systematic review examines the relationship between injury and two stages of a dancer's career development: when transitioning to full-time training and to a professional dance company. The findings are discussed in relation to managing transitioning loads with regard to injury prevention. Six electronic databases (PubMed, Embase, CINAHL, SPORTDiscus, Scopus, and Performing Arts Periodicals Database) were searched from inception to July 2018, inclusive of English language peer reviewed studies investigating injury in pre-professional and professional ballet and contemporary dancers. Seventeen studies met the inclusion criteria. "Limited" evidence revealed that dancers transitioning to professional ballet had a significantly higher rate of time-loss injuries per exposure hour relative to established professionals, whereas transitioning professional contemporary dancers had a significantly lower rate of both medical-attention and time-loss injuries. "Limited" evidence also showed a decreased rate and trend toward lower prevalence rates for time-loss injuries per exposure hour for transitioning ballet students and an increased rate of medical-attention injury in a combined cohort of transitioning ballet and contemporary dance students. Thus, this review provides some evidence that injuries tend to occur as dancers are transitioning to full-time ballet or contemporary dance training or to professional careers.
... It was noted that blocks of performances brought about increases in aerobic fitness parameters of professional contemporary dancers [29]. Furthermore, professional contemporary dancers showed higher levels of aerobic fitness than pre-professional students, which is likely a reflection of their greater performing schedules [30]. For dance students, a majority of time is spent developing technique through classwork [31], whereas professional dancers, having already established a solid technical base, spend a larger proportion of their day rehearsing and performing. ...
Article
Full-text available
Dancers are an athlete population at high risk of developing iron deficiency (ID). The aesthetic nature of the discipline means dancers potentially utilise dietary restriction to meet physique goals. In combination with high training demands, this means dancers are susceptible to problems related to low energy availability (LEA), which impacts nutrient intake. In the presence of LEA, ID is common because of a reduced mineral content within the low energy diet. Left untreated, ID becomes an issue that results in fatigue, reduced aerobic work capacity, and ultimately, iron deficient anaemia (IDA). Such progression can be detrimental to a dancer’s capacity given the physically demanding nature of training, rehearsal, and performances. Previous literature has focused on the manifestation and treatment of ID primarily in the context of endurance athletes; however, a dance-specific context addressing the interplay between dance training and performance, LEA and ID is essential for practitioners working in this space. By consolidating findings from identified studies of dancers and other relevant athlete groups, this review explores causal factors of ID and potential treatment strategies for dancers to optimise absorption from an oral iron supplementation regime to adequately support health and performance.
... 14,15 Researchers have identified several risk factors for injuries in younger dancers, such as increased growth rate, history of previous injuries, lower or higher Beighton scores, decreased technique motorcontrol, lower extremity muscle tightness, female sex, and fewer years of dance training. 14,16,17 Bronner et al. 18 have emphasized the importance of pre-season screening programs and aerobic training at the pre-professional level as a preparation for the demands of a professional career. Unfortunately, these screenings are not systematically implanted in dance education institutions in Quebec. ...
Article
Objective: To understand dancers' perception of accessibility to care and quality of the relationship with healthcare practitioners in Quebec; to identify the key elements of an optimal dancer-physician relationship; and to propose recommendations for improvement. Methods: An online questionnaire consisting of multiple choice, "yes/no," and short answer questions was sent to professional dance organizations, companies, agencies, and schools in Quebec, Canada. Information regarding the dance artists' sociodemographics, dance background, dance-related injuries, and access to a primary care physician were collected. Experiences and expectations regarding the dancer-physician relationship were surveyed. One-way ANOVA analyses and Pearson correlations were performed to assess differences of perception between dancers' demographic characteristics and associations between the variables. Results: Out of 161 participants, 144 met inclusion criteria, consisting of largely French-speaking females, North American or European decent, self-employed contemporary dancers with an average age of 33.13 ± 10.81 yrs. Dance artists sought medical care from osteopaths (47.9%) and physiotherapists (36.1%) more frequently than from physicians (8.3%). Fully employed dancers had more favorable perceptions of the dancer-physician relationship compared to self-employed dancers and those who had mixed streams of income. The perception of most participants was that physicians do not comprehend the unique dance-associated impacts on health (81.8%). The most important aspect affecting perception of the relationship with the physician was diagnostic acumen (41.3%). Most participants (79.0%) selected "works with other health professionals [...] and gives expert advice" as an important expectation from physicians. Conclusion: This research is the first investigation of the dancer-physician relationship in Quebec. It reveals a desire amongst the dance artist community to improve the dancer-physician relationship and the overall quality of their unique healthcare requirements.
... The minimal level of cross-training undertaken may suggest such specialisation in this cohort. The benefits of cross-training in dance include improved aerobic capacity and preparation for a professional career (Bronner, Codman, Hash-Campbell, & Ojofeitimi, 2016). Appropriate cross-training may be even more important in ID, which stylistically has a comparatively limited repertoire of movement, with a concomitant over-reliance on a smaller number of muscle groups. ...
Article
Objectives: To investigate dance exposure, sleep, general health and injury in elite adolescent Irish dancers. Design: Prospective study. Setting: Six Irish dance schools in Ireland. Participants: Thirty-seven elite Irish dancers, aged 13-17, competing at the highest championship level for at least the previous year. Main outcome measures: Self-reported weekly hours of dance, general health, sleep quality, monthly and annual height and weight, injury incidence. Results: Overall injury incidence (time-loss plus non-time-loss) and time-loss only injury incidence were 9.3 injuries, and 4.5 injuries, per 1000 hours of dance respectively. At least one injury was incurred by 86.5% of participants, with the foot/ankle most commonly affected. There were no statistically significant associations (p>0.05) between injury and sleep quality, or annual change in height/weight. There was some evidence of a statistically significant association between injury and health quality, with poorer health associated with increased levels of injury. There was no evidence of a statistically significant association between the probability of injury over time and sleep quality one week earlier, health quality one week earlier, or training load one and two weeks earlier. Conclusions: The incidence of injury in elite adolescent Irish dance is considerable with many dancers continuing to dance when injured. Increased dance exposure is associated with new injury.
... It has been proposed in the literature that some dancers will avoid cross-training, believing it to adversely affect dance ability (Miller and Miller III, 2017). However, cross-training for pre-professional dancers has been advocated to prepare them for a professional career (Bronner, Codman, Hash-Campbell, & Ojofeitimi, 2016). In this study, levels of cross-training were low and remained relatively constant throughout the year regardless of hours danced and/or injury. ...
Article
Objectives: Dance exposure and determinants of wellness in Irish dance (ID) and contemporary dance (CD) are under-investigated in pre-professional, collegiate cohorts. This study prospectively investigated these variables in ID and CD participants for one year. Design: Prospective study. Setting: University-level institutes of dance, United Kingdom (UK) and Ireland. Participants: Fifty (ID = 21, CD = 29) full time students of dance at Trinity Laban Conservatoire of Music and Dance, (UK) and the University of Limerick, Ireland. Main outcome measures: Weekly hours of dance, general health, sleep quality, injury defined as "any pain or injury that impacted upon their ability to dance". Results: Dance exposure varied considerably for both genres across the year. CD participants danced for more hours weekly (p < 0.001). Overall injury incidence (time-loss and non-time-loss) was 10.6 and 8.4 injuries per 1000 h dancing for ID and CD groups respectively. 70.4% of injuries were non-time-loss. Better sleep (p = 0.007) and general health (p < 0.001) scores were negatively correlated with days lost/impacted by injury. CD participants reported a significantly higher dance exposure in the week prior to a time-loss injury than during the previous four weeks (p = 0.044). Conclusions: Dance exposure is erratic in these cohorts with dancers frequently performing when injured. Poor sleep, general health, and increased dance exposure may be associated with injury.
Chapter
In addition to the annual dance steps teaching plan, a training plan designed for the dancer to reach the main presentation's peak performance is required. This training plan is called periodisation and seems to be a great tool for optimizing performance and avoiding overtraining. This chapter addresses the concepts of periodization translated by sport and association with the conditions found in dance. The manipulation of the volume and intensity of the dancer's integral training will be at the heart of the periodisation proposed in this chapter. The division of phases of a company's season or a year in the dance school will be analysed. The different phases aim to prepare the dancer's body for this activity's demands, improving and maintaining one performance, health, and quality of life.
Article
Dancers in a liberal arts program of study are an underrepresented group in the field of dance science and dance education literature. Dancers in this environment come with a broad range of interests and typically strive for high academic achievements outside of their dance studies. Therefore, their patterns of training and injury might be different than dancers typically studied in this field. This study sought to track dance exposure within a liberal arts collegiate dance department as it was hypothesized that dancers’ actual dance exposure time (AE) would be greater than their registered exposure time (RE). Self-reported injuries were also collected to assess incidence of injury. The findings of this study suggest a high incidence of injury and a statistically significant difference in AE versus RE. A customized periodization training program is recommended to assist institutions in combating these patterns within their own program.
Article
Full-text available
While there is currently a validated dance-specific exercise method of measuring aerobic fitness, no such test has been developed to measure high intensity capabilities in dance. The purpose of this study was to initiate an intermittent high intensity dance-specific fitness test. The test was designed to be able to observe changes in heart rate (HR), thereby allowing for a measurement of physical fitness at high intensities. Sixteen professional dancers (4 males and 12 females) volunteered to take part in this study. The fitness test protocol consists of movements that are representative of contemporary dance, and contains exercise and rest periods that mimic the intermittent nature of dance. The participants performed four trials. The physiological variables measured were HR (b·min-1) for each one minute bout of the four minute test for all trials, oxygen uptake (VO 2) throughout the test, and end blood lactate (BLa mmol·L) for each trial. In addition, five of the participants undertook a maximal oxygen uptake treadmill test, and the scores obtained were compared with those from the dance test. Results show HR consistency across each one minute bout of the test and across each of the four trials of testing for all participants, indicating that the test is reliable. There was good reliability between bouts of each trial (typical error as % of CV = 1.5), intraclass " r " = 0.8, and good reliability between the four trials (typical error as % of CV = 2.1), intraclass " r " = 0.82. There were no significant differences between the maximal VO 2 and BLa scores established in the treadmill and dance tests, demonstrating validity. Thus, the results of this study indicate that the high intensity dance-specific test is a reliable and valid means of assessing and monitoring the cardiovascular fitness of dancers. The test allows dancers to be assessed within an environment that they are accustomed to (the studio), using a mode of exercise that is relevant (dance), and it is of adequate intensity to be representative of performance. R egular monitoring of adaptations from any training regimen is advisable so that the effect of that training can be measured and modified as necessary. In dance training , the monitoring of skill and technical improvements often prevails over other concerns; thus, dancers' physiological development and preparation for performance has been somewhat overlooked. There have been previous attempts at measuring the energy demands of dance and the fitness status of dancers. 1-7 A rise in blood lactate (BLa) above 4 mmol·L-1 is an indicator that ATP demand cannot be met solely by aerobic glycolysis and that the proportion of energy derived from anaerobic pathways has increased. Previous research has noted BLa values of 10 mmol.L-1 during dance performance. 2 Another method for measuring exercise intensity is via heart rate and oxygen uptake recordings. Cohen and colleagues noted peak HR values of 184 b·min-1 and a mean HR of 169 b·min-1 during dance performance. 1 The same investigators found that dancers perform at 90% of their maximum HR for short amounts of time. Wyon and colleagues noted that the mean oxygen demand and heart rate of dance performance was significantly greater than that seen during rehearsal and class. 6 Though the dance class reached the same aerobic intensities as performance (55+ ml·kg-1 ·min-1), significantly less time was spent there, and rehearsals rarely exposed the dancer to these intensities. Dance appears to be an intermittent activity that utilizes both the aerobic and anaerobic energy systems. 2-7 In order to ensure that appropriate physiological improvements occur, it is therefore important that dance scientists and educators monitor both the demands of dance performance and dancers' aerobic and anaerobic fitness levels.
Article
Full-text available
Wellness programs are being increasingly employed with performing artists. Given their aim of reducing injuries, injury tracking is commonly employed as an outcome measure. Evaluating the development and process of a wellness program can also enhance its effectiveness. Developmental evaluation offers one methodological framework within which to conduct such investigations. This paper reports on a 2-year process involving feedback from professional ballet dancers, management and artistic staff, and healthcare providers at a ballet company in order to develop a dancer screening and wellness program. Following a consultation phase, an initial program composed of an expanded medical team and annual injury prevention screen was proposed. Alongside implementation with 30 professional ballet dancers, formal and informal feedback was sought from stakeholders and members across all levels of the ballet company to facilitate ongoing development, evaluation, and revision of the wellness program. The use of a process informed by developmental evaluation helped identify strengths and limitations within the screening process. The collective expertise of the assessors was used to modify the components and process of the screen to strive for ecological appropriateness.The process also fostered buy-in from all involved. Participant feedback helped refine the medical team available to the dancers and influenced the treatment and referral pathways via which dancers are able to access each member of the medical team. Furthermore, reflective discussions with artistic and management staff brought to light potential interactions between repertoire programming, fitness, and injury patterns. This prompted a reconsideration of how artists are trained and supported. Evaluation methods that focus on experiences and insight gained during program development stand to result in more efficient screening programs and health-promotion models and, ultimately, healthier performing artists.
Article
Full-text available
While studies have investigated the physical demands of dance in terms of cardiorespiratory fitness, there are no recent comparisons of cardiorespiratory response to exercise among professional dancers of different genres. Our purpose was to: 1. develop a cardiorespiratory profile of professional dancers; 2. investigate differences in peak and recovery heart rate (HR) between professional modern and ballet dancers using an accelerated 3-minute step test; 3. demonstrate the relationship between cardiorespiratory variables; and 4. investigate the effects of company and work variables on the dancers' cardiorespiratory profiles. We hypothesized greater cardiorespiratory fitness in modern dancers than in ballet dancers, due to the nature of their repertory. Furthermore, we hypothesized that company profiles would reflect differences in work variables. Two hundred and eleven dancers (mean age 24.6 ± 4.7) from nine companies (two modern and seven ballet) performed a 3-minute step test. Demographics, height, mass, blood pressure (BP), smoking history, and resting peak and recovery HR were recorded. Body mass index (BMI) and fitness category were calculated. Independent t-tests were used to compare differences in demographics and cardiorespiratory variables due to genre, MANOVA were conducted to compare differences due to company, and correlations were calculated to determine the relationships between cardiorespiratory variables (p Modern dancers demonstrated higher mass and BMI, lower BP, lower resting HR and HR recovery, and a higher percentage were categorized as "fit" compared to ballet dancers (p Document Type: Research Article DOI: http://dx.doi.org/10.12678/1089-313X.18.2.74 Affiliations: 1: ADAM Center, Department of Physical Therapy, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, Massachusetts 02115, USA; Physical Therapy Services, Alvin Ailey American Dance Theater, New York, New York, USA. shaw.bronner@gmail.com 2: Alvin Ailey American Dance Theater, New York, New York, USA 3: Physical Therapy & Sports Medicine Center, Palisades Medical Center, North Bergen, New Jersey, USA 4: Physical Therapy Services, Boston Ballet, Boston, Massachusetts, USA 5: Department of Physical and Occupational Therapy Services, Children's Hospital, Boston, Massachusetts, USA 6: Body Dynamics, Inc., Arlington, Virginia, USA; Health and Wellness Services, The Washington Ballet and The Washington School of Ballet, Washington DC, USA 7: NovaCare Rehabilitation, St. Paul, Minnesota, USA 8: Texas Healthcare Bone and Joint Physical Therapy, and Medical Consultant at the Texas Ballet Theater, Fort Worth, Texas, USA 9: San Francisco Ballet, San Francisco, California, USA Publication date: June 1, 2014 More about this publication? Editorial Board Information for Authors Membership Information ingentaconnect is not responsible for the content or availability of external websites $(document).ready(function() { var shortdescription = $(".originaldescription").text().replace(/\\&/g, '&').replace(/\\, '<').replace(/\\>/g, '>').replace(/\\t/g, ' ').replace(/\\n/g, ''); if (shortdescription.length > 350){ shortdescription = "" + shortdescription.substring(0,250) + "... more"; } $(".descriptionitem").prepend(shortdescription); $(".shortdescription a").click(function() { $(".shortdescription").hide(); $(".originaldescription").slideDown(); return false; }); }); Related content In this: publication By this: publisher In this Subject: Arts (General) , Medicine (General) , Therapeutics & Alternative Medicine By this author: Bronner, Shaw ; Ojofeitimi, Sheyi ; Lora, Jennifer Bailey ; Southwick, Heather ; Kulak, Michelina Cassella ; Gamboa, Jennifer ; Rooney, Megan ; Gilman, Greg ; Gibbs, Richard GA_googleFillSlot("Horizontal_banner_bottom");
Article
Full-text available
As the technical performance demands of dance increase, professional companies and pre-professional schools are implementing pre-season screenings that require an efficient, cost effective way to measure dancer aerobic fitness. The aim of this study was to assess an accelerated 3-minute step test (112 beats·min(-1)) by comparing it to the well-studied YMCA step test (96 beats·min(-1)) and a benchmark standard, an incremental treadmill test, using heart rate (HR) and oxygen consumption (VO2) as variables. Twenty-six professional and pre- professional dancers (age 20 ± 2.02 years) were fitted with a telemetric gas analysis system and HR monitor. They were tested in the following order: 96 step, 112 step, and treadmill test, with rest to return to baseline heart rate between each test. The step and treadmill tests were compared using Intra-class Correlation Coefficients [ICC (3, k)] calculated with analysis of variance (p < 0.05). To determine whether there was a relationship between peak and recovery HR (HRpeak, HRrecov) and VO2(VO2peak, VO2recov) variables, Pearson product moment correlations were used. Differences due to gender or group (pre- professionals versus professionals) were explored with MANOVAs for HRpeak, VO2peak, HRrecov, VO2recov, and fitness category. The 112 step test produced higher HRpeak and VO2peak values than the 96 step test, reflecting a greater workload (p < 0.001). For HRpeak, there were high correlations (r = 0.71) and for HRrecov, moderate correlations (r = 0.60) between the 112 step test and treadmill test. For VO2peak and VO2recov, there were moderate correlations between the 112 step test and treadmill test (r = 0.65 and 0.73). No differences between genders for VO2peak values were found for either step test, but males displayed lower HRpeak values for both step tests and higher VO2peak values during the treadmill test (p < 0.001). Recovery HR was lower in males for the 96 and 112 step tests (p < 0.05). This was reflected in higher fitness scores. There were no differences between groups in any of the variables when only females were compared. For the 112 step test, correlations between HRpeak and HRrecov were high (r = 0.85), and correlations between HRpeak and fitness category were very high (r = 0.98). It is concluded that the 112 step test provides an efficient, acceptable tool for testing dance populations, though further testing in larger groups of dancers representing a diverse range of genres and training levels is needed.
Article
Full-text available
In this study, the effects of cigarette smoking on maximal aerobic capacity, anaerobic capacity, and heart rate variability among female university students were investigated. Twelve smokers and 21 nonsmokers participated in this study. All participants performed an intermittent sprint test (IST) and a 20 m shuttle run test to measure their anaerobic capacity and maximal aerobic capacity. The IST was comprised of 6 × 10-second sprints with a 60-second active recovery between each sprint. Heart rate variability was recorded while the participants were in a supine position 20 minutes before and 30 minutes after the IST. The total work, peak power, and heart rate of the smokers and nonsmokers did not differ significantly. However, the smokers' average power declined significantly during sprints 4 to 6 (smokers versus nonsmokers, respectively: 95% confidence interval =6.2-7.2 joule/kg versus 6.8-7.6 joule/kg; P<0.05), and their fatigue index increased (smokers versus nonsmokers, respectively: 35.8% ± 2.3% versus 24.5% ± 1.76%; P<0.05) during the IST. The maximal oxygen uptake of nonsmokers was significantly higher than that of the smokers (P<0.05). The standard deviation of the normal to normal intervals and the root mean square successive difference did not differ significantly between nonsmokers and smokers. However, the nonsmokers exhibited a significantly higher normalized high frequency (HF), and significantly lower normalized low frequency (LF), LF/HF ratio, and natural logarithm of the LF/HF when compared with those of the smokers (P<0.05). Smoking may increase female smokers' exercise fatigue and decrease their average performance during an IST, while reducing their maximal aerobic capacity. Furthermore, smoking reduces parasympathetic nerve activity and activates sympathetic cardiac control.
Article
Full-text available
Supplementary Low-Intensity Aerobic Training Improves Aerobic Capacity and Does Not Affect Psychomotor Performance in Professional Female Ballet Dancers We investigated whether 6-week low-intensity aerobic training program used as a supplement to regular dance practice might improve both the aerobic capacity and psychomotor performance in female ballet dancers. To assess their maximal oxygen uptake (VO2max) and anaerobic threshold (AT), the dancers performed a standard graded bicycle ergometer exercise test until volitional exhaustion prior to and after the supplementary training. At both these occasions, the psychomotor performance (assessed as multiple choice reaction time) and number of correct responses to audio-visual stimuli was assessed at rest and immediately after cessation of maximal intensity exercise. The supplementary low-intensity exercise training increased VO 2max and markedly shifted AT toward higher absolute workload. Immediately after completion of the graded exercise to volitional exhaustion, the ballerinas' psychomotor performance remained at the pre-exercise (resting) level. Neither the resting nor the maximal multiple choice reaction time and accuracy of responses were affected by the supplementary aerobic training. The results of this study indicate that addition of low-intensity aerobic training to regular dance practice increases aerobic capacity of ballerinas with no loss of speed and accuracy of their psychomotor reaction.
Article
Although dancing requires extensive physical exertion, dancers do not often train their physical fitness outside dance classes. Reduced aerobic capacity, lower muscle strength and altered motor control have been suggested as contributing factors for musculoskeletal injuries in dancers. This randomized controlled trial examined whether an intervention program improves aerobic capacity and explosive strength and reduces musculoskeletal injuries in dancers. Forty-four dancers were randomly allocated to a 4-month conditioning (i.e. endurance, strength and motor control training) or health promotion program (educational sessions). Outcome assessment was conducted by blinded assessors. When accounting for differences at baseline, no significant differences were observed between the groups following the intervention, except for the subscale “Pain” of the Short Form 36 Questionnaire (p=0.03). Injury incidence rate and the proportion of injured dancers were identical in both groups, but dancers following the conditioning program had significant less low back injuries (p=0.02). Supplementing regular dance training with a 4-month conditioning program does not lead to a significant increase in aerobic capacity or explosive strength in pre-professional dancers compared to a health promotion program without conditioning training, but leads to less reported pain. Further research should explore how additional training may be organized, taking into account the demanding dance schedule of pre-professional dancers. The trial is registered at ClinicalTrials.gov, number NCT01440153.
Article
Abstract The present investigation was aimed to study international level dancesport dancer's aerobic capacity during incremental test and competition simulation in relation to the gender, dance style and international ranking. A total of 30 couples (12 Standard, 7 Latin American and 11 Ten Dance; aged 22.8±6.6 years male and 22.0±6.4 years female) performed an incremental treadmill test and competition simulation. In this study for the first time we carried out longer than one round competition simulation and compared three different dancesport styles (Standard, Latin American and Ten Dance). The results showed that dancers of these three dance styles had similar aerobic capacity values. The average maximal oxygen consumption ([Vdot]O2max) values were 59.6±5.1 and 51.2±6.2 ml·min(-1)·kg(-1) for male and female dancers, respectively. Competition simulation showed that Latin American Dance discipline is physiologically more intensive compared to Standard and Ten Dance styles especially for the female dancers. It appeared that male and female Standard dancers tended to perform at lower intensity than anaerobic threshold (AT) during competition simulation (male 97.3±2.9%; female 97.9±3.6%), while Latin (male 101.4±2.9%; female 106.7±5.9%) and Ten Dance (male 100.7±6.4%; female 99.2±5.6%) competition intensity was higher compared to AT level of athletes. The highest heart rate during competition simulation was always found during the last dances (Paso Double, Jive or Quickstep) and in the last round of each dance style. No significant relationship between [Vdot]O2max values and international rankings was registered.
Article
Purpose: This study investigated associations between injuries and individual components of the Marine Corps physical fitness test (PFT), self-reported exercise and previous injury history, and Functional Movement Screen (FMS) scores. Methods: A cohort of 874 men enrolled in either 6 wk (n = 447) or 10 wk (n = 427) of Marine Corps officer candidate training was recruited. They completed an exercise history questionnaire, underwent an FMS during medical in-processing, and completed the standardized PFT (pull-ups, abdominal crunch, and 3-mile run) within 1 wk of training. Injury data were gathered throughout training from medical records and classified into overuse, traumatic, and any injury. Results: Three-mile run time (RT) was the only PFT component predictive of injury: candidates with RT ≥20.5 min were 1.7 times (95% confidence interval = 1.29-2.31, P < 0.001) more likely to experience an injury compared with those with RT <20.5 min. Prior injury, frequency of general exercise and sport participation, and length of running history were predictive of any, overuse, and traumatic injuries, respectively. Combining slow RT and low FMS scores (≤14) increased the predictive value across all injury classifications: candidates scoring poorly on both tests were 4.2 times more likely to experience an injury. The pull-up to exhaustion test was related to four of the seven FMS tests and the only PFT test positively related to total FMS score, although correlations were generally low (r ≤ 0.11). Conclusion: Slow RT was associated with increased injury risk, and combining poor RT and low FMS scores significantly increased the injury predictive value. Additional research is warranted to further clarify what combination of PFT and FMS tests are most suitable for predicting injuries.